Meeting children's basic health needs: From patchwork to tapestry

Few would deny that if a system were to be designed de novo to meet children's basic health needs, it would be radically different from the confusing and fragmented patchwork of programs in place today. While Medicaid and the Children's Health Insurance Program (CHIP), have improved access to care, increased use of health care services, and reduced unmet health needs for low-income children, the impact of these programs on the quality of health care, and on children's health outcomes is less certain. At the same time, the prevalence of childhood chronic illness is increasing, there is an "epidemic" of obesity, and sizeable increases in reported developmental and behavioral problems and mental health issues. Our existing system of care appears ill-equipped to respond to this changing epidemiology. Unmet needs for care in childhood represent "time-bombs," likely to result in an explosion of chronic illness in mid-life. We propose a new approach to child health policy, based on the life course health development model in which health in childhood is regarded as a foundation for lifelong well-being. A new tapestry of comprehensive children's services, integrated across sectors, which fully address children's health needs and promote positive health, could set children on optimal health trajectories for life. This system could be a major component of the transformative change the nation is seeking to reduce health care costs and improve quality of life across the lifespan.